Atherosclerotic Renal Artery Stenosis

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Atherosclerosis is the most common cause of renal artery stenosis. Clinical features that are suspicious for renal artery stenosis include abrupt-onset or accelerated hypertension at any age, hypertension at a young age, unexplained acute or chronic azotemia, azotemia induced by an an-giotensin-converting enzyme (ACE) inhibitors, asymmetric renal dimensions, and congestive heart failure with normal ventricular function.El-derly patients with generalized atherosclerosis and hypertension often have atherosclerotic renal artery stenosis. Typically the aorta is atherosclerotic (Fig. 2) and disease in the aorta extends into the renal artery origins, thereby compromising renal blood flow. These atherosclerotic stenoses are often progressive, tend to involve the ostium or proximal third of the renal artery, and are frequently eccentric. It is important to mention that atherosclerotic stenoses my as well be found in accessory renal arteries (Fig. 8a-c) which are typically hard to diagnose on ultrasound. Hypertension in these patients may not be entirely renin-dependent (i.e., essential hypertension). Renal artery revascularization with stenting may be considered for refractory severe hypertension, and would be expected

Renal Artery Stenosis Ultrasound

Fig. 8a-c. Renal artery stenosis of a lower polar artery (Gd-BOP-TA, 0.1 mmol/kg). On the whole volume MIP a stenosis of a lower polar artery is evident (arrowin a). This is even better displayed in a targeted subvolume MIP (arrowin b) with good correlation with conventional angiography (c) [Images courtesy of Dr. G. Schneider]

Fig. 8a-c. Renal artery stenosis of a lower polar artery (Gd-BOP-TA, 0.1 mmol/kg). On the whole volume MIP a stenosis of a lower polar artery is evident (arrowin a). This is even better displayed in a targeted subvolume MIP (arrowin b) with good correlation with conventional angiography (c) [Images courtesy of Dr. G. Schneider]

to improve blood pressure control and modestly reduce medication requirements. Curing hypertension with renal revascularization in these patients is less likely.

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